Browsing by Author "Heit, Michael"
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Item Increasing Anteroposterior Genital Hiatus Widening Does Not Limit Apical Descent for Prolapse Staging during Valsalva’s Maneuver: Effect on Symptom Severity and Surgical Decision Making(Wolters Kluwer, 2018-11) Guanzon, Anna; Heit, Michael; Khoder, Waseem; Obstetrics and Gynecology, School of MedicineObjective: Determine if anteroposterior genital hiatus (GH) widening obscures rather than facilitates signs and symptoms, inadvertently altering management decisions for women with pelvic organ prolapse (POP) during Valsalva's Maneuver, at a given total vaginal length (TVL). Methods: We performed a retrospective cohort with nested cross-sectional study of patients who underwent POP surgery. Data from obstetric and gynecologic history, preoperative and postoperative physical examinations, and 20-item Pelvic Floor Distress Inventory (PFDI-20) and 7-item Pelvic Floor Impact Questionnaire (PFIQ-7) scores were extracted. Study participants were compared in 2 groups: anteroposterior widened (>3 cm) and not widened (<=3 cm) GH, for baseline leading edge and POP stage, while controlling for TVL. Baseline PFDI-20 and PFIQ-7 scores were evaluated within GH groups. Delta GH, PFDI-20, and PFIQ-7 scores after apical suspension with and without posterior colporrhaphy were compared to assess the clinical value of the procedure. Results: Study participants with anteroposterior GH widening during Valsalva maneuver had greater baseline leading edge descent and higher POP stage compared with those without anteroposterior GH widening after controlling for TVL. Baseline PFDI-20 and PFIQ-7 scores were similar within both GH categories controlling for prolapse severity. Adding posterior colporrhaphy to apical suspension resulted in a greater anteroposterior GH reduction without improving delta PFDI-20 or PFIQ-7 scores. Conclusions: Facilitation through herniation rather than obscuration from anteroposterior GH widening explains why patients will not be undertreated based on signs and symptoms of disease. Adding posterior colporrhaphy to apical suspension more effectively reduces anteroposterior GH widening without differential improvement in symptoms rendering the operation to no more than a cosmetic procedure.Item Operationalizing Postdischarge Recovery From Laparoscopic Sacrocolpopexy for the Preoperative Consultative Visit(Wolters Kluwer, 2021-07) Heit, Michael; Carpenter, Janet S.; Chen, Chen X.; Rand, Kevin L.; Obstetrics and Gynecology, School of MedicineObjective The objective was to establish a threshold for postdischarge surgical recovery from laparoscopic sacrocolpopexy for the preoperative consultative visit to answer the “what is my recovery time?” question. Methods Study participants (N = 171) with stage 2 or worse pelvic organ prolapse undergoing laparoscopic sacrocolpopexy who completed postoperative surveys at 4 time points. Postdischarge Surgical Recovery 13 (PSR13) scores were anchored to a Global Surgical Recovery (GSR) tool (if 100% recovery is back to your usual health, what percentage of recovery are you now?). Weighted mean PSR13 scores were calculated as a sum of the products variable when patients considered themselves 80 to less than 85, 85 to less than 90, 90 to less than 95, or 95 to 100 percent recovered on the GSR tool. The percentage of study participants recovered at postdischarge day 7, 14, 42, and 90 was calculated based on a comparison between the GSR scores and weighted mean PSR13 scores. Results A PSR13 score of 80 or greater, corresponding to 85% or greater recovery, was seen in 55.6% (42 days) and 50.9% (90 days) of study participants, respectively, establishing this numeric threshold as representing “significant” postdischarge recovery after laparoscopic sacrocolpopexy. At 14 days after discharge, only 16.4% of the study population achieved this PSR13 score. Conclusions Most study subjects were “significantly” recovered at 42 days after laparoscopic sacrocolpopexy using a PSR13 score of 80 or greater as a numeric threshold. There is a need to determine the population percentage of recovered study subjects at 30, 60, and beyond 90 days from laparoscopic sacrocolpopexy.Item Operationalizing the Measurement of Socioeconomic Position in Our Urogynecology Study Populations: An Illustrative Review(Wolters Kluwer, 2017-05) Heit, Michael; Guirguis, Nayera; Kassis, Nadine; Takase-Sanchez, Michelle; Carpenter, Janet; Obstetrics and Gynecology, School of MedicineObjectives The purpose of this illustrative review is to provide guidance for the measurement of socioeconomic position when conducting health disparities research in urogynecology study populations. Methods Deidentified data were extracted from existing investigational review board–approved research databases for illustrative purposes. Attributes collected included the study participant's marital status, level of educational attainment (in number of years of school completed) and occupation as well as the study participant's last/only spouses' level of education and occupation. Average household and female socioeconomic position scores were calculated using two established composite indices: (1) Hollingshead Four Factor Index of Social Position, (2) Green's Socioeconomic Status scores, and 2 single-item indices: (1) Hauser-Warren Socioeconomic Index of Occupation, (2) level of educational attainment. Results The Hollingshead Four Factor Index of Social Position more than the Hauser-Warren Socioeconomic Index of Occupation provides researchers with a continuous score that is normally distributed with the least skew from the dataset. Their greater standard deviations and low kurtotic values increase the probability that statistically significant differences in health outcomes predicted by socioeconomic position will be detected compared with Green's socioeconomic status scores. Conclusions Collection of socioeconomic data is an important first step in gaining a better understanding of health disparities through elimination of confounding bias, and for the development of behavioral, educational, and legislative strategies to eliminate them. We favor average household socioeconomic position scores over female socioeconomic position scores because average household socioeconomic position scores are more reflective of overall resources and opportunities available to each family member.Item Predictors of Postdischarge Surgical Recovery Following Laparoscopic Sacrocolpopexy: A Prospective Cohort Study(Lippincott, Williams & Wilkins, May 2020) Heit, Michael; Carpenter, Janet S.; Chen, Chen X.; Stewart, Ryan; Hamner, Jennifer; Rand, Kevin L.; Obstetrics and Gynecology, School of MedicineObjectives Our aim was to identify sociodemographic/clinical, surgical, and psychosocial predictors of postdischarge surgical recovery after laparoscopic sacrocolpopexy. Methods Study participants (N=171) with ≥ stage 2 pelvic organ prolapse completed a preoperative survey measuring hypothesized sociodemographic/clinical, surgical, and psychosocial recovery predictors followed by a postoperative survey at four time points (day 7, 14, 42, and 90) that included the Postdischarge Surgical Recovery (PSR)13 scale. One multivariate linear regression model was constructed for each time point to regress PSR13 scores on an a priori set of hypothesized predictors. All variables that had p values less than 0.1 were considered significant predictors of recovery because of the exploratory nature of this study and focus on model building rather than model testing. Results Predictors of recovery at one or more time points included the following: Sociodemographic/clinical predictors: older age, higher body mass index, fewer comorbidities, and greater preoperative pain predicted greater recovery. Surgical predictors: fewer perioperative complications and greater change in the leading edge of prolapse after surgery predicted greater recovery. Psychosocial predictors: less endorsement of doctors locus of control, greater endorsement of others locus of control, and less sick role investment predicted greater recovery. Conclusions Identified sociodemographic/clinical, surgical, and psychosocial predictors should provide physicians with evidence based guidance on recovery times for patients and family members. This knowledge is critical for informing future research to determine if these predictors are modifiable by changes to our narrative during the preoperative consultation visit. These efforts may reduce the postdischarge surgical recovery for patients with pelvic organ prolapse after laparoscopic sacrocolpopexy, accepting the unique demands on each individual’s time.Item Recovery expectancies impact postdischarge recovery 42 days after laparoscopic sacrocolpopexy(Springer, 2021-06) Heit, Michael; Chen, Chen X.; Pan, Christine; Rand, Kevin L.; Obstetrics and Gynecology, School of MedicineIntroduction and hypothesis The aim of this retrospective cohort study was to determine if recovery expectancies were associated with actual postdischarge recovery after laparoscopic sacrocolpopexy. Methods Study subjects (N = 167) undergoing laparoscopic sacrocolpopexy were asked to preoperatively predict the likelihood of a prolonged postdischarge recovery (> 42 days). Low, medium, and high recovery expectancy groups were created from responses to the likelihood of prolonged postdischarge recovery question. Previously established predictors of actual recovery 42 days after laparoscopic sacrocolpopexy included age, body mass index, Charlson co-morbidity index, short form (SF)-36 bodily pain scores, doctors’ and others’ health locus of control, and sick role investment. One parsimonious hierarchical linear and logistic regression model was constructed to determine if preoperative recovery expectancies were independently associated with PSR13 scores and “significant” postdischarge recovery after controlling for previously established predictors. Results Study subjects with high recovery expectancies had higher PSR13 scores than subjects with low recovery expectancies (82.32 ± 15.34 vs 73.30 ± 15.30, mean difference 9.01, 95%CI 1.08–16.94). Study subjects with low recovery expectancies scored 7.7 points lower on the PSR13 scale (minimally important difference = 5), which translated into a 73% reduction in the likelihood of being “significantly” recovered 42 days after surgery, after controlling for previously established predictors. Conclusions A low recovery expectancy has a negative impact on actual recovery 42 days after laparoscopic sacrocolpopexy. Our findings are important because preoperative recovery expectancies are modifiable predictors, making them a candidate for an expectancy manipulation intervention designed to optimize recovery after pelvic reconstructive surgery.Item Surgical Outcomes in Benign Gynecologic Surgery Patients during the COVID-19 Pandemic (SOCOVID study)(Elsevier, 2022-02) Kho, Rosanne M.; Chang, Olivia H.; Hare, Adam; Schaffer, Joseph; Hamner, Jen; Northington, Gina M.; Metcalfe, Nina Durchfort; Iglesia, Cheryl B.; Zelivianskaia, Anna S.; Hur, Hye-Chun; Seaman, Sierra; Mueller, Margaret G.; Milad, Magdy; Ascher-Walsh, Charles; Kossl, Kelsey; Rardin, Charles; Siddique, Moiuri; Murphy, Miles; Heit, Michael; Obstetrics and Gynecology, School of MedicineStudy Objective To determine the incidence of perioperative coronavirus disease (COVID-19) in women undergoing benign gynecologic surgery and to evaluate perioperative complication rates in patients with active, previous, or no previous severe acute respiratory syndrome coronavirus 2 infection. Design A multicenter prospective cohort study. Setting Ten institutions in the United States. Patients Patients aged >18 years who underwent benign gynecologic surgery from July 1, 2020, to December 31, 2020, were included. All patients were followed up from the time of surgery to 10 weeks postoperatively. Those with intrauterine pregnancy or known gynecologic malignancy were excluded. Interventions Benign gynecologic surgery. Measurements and Main Results The primary outcome was the incidence of perioperative COVID-19 infections, which was stratified as (1) previous COVID-19 infection, (2) preoperative COVID-19 infection, and (3) postoperative COVID-19 infection. Secondary outcomes included adverse events and mortality after surgery and predictors for postoperative COVID-19 infection. If surgery was delayed because of the COVID-19 pandemic, the reason for postponement and any subsequent adverse event was recorded. Of 3423 patients included for final analysis, 189 (5.5%) postponed their gynecologic surgery during the pandemic. Forty-three patients (1.3% of total cases) had a history of COVID-19. The majority (182, 96.3%) had no sequelae attributed to surgical postponement. After hospital discharge to 10 weeks postoperatively, 39 patients (1.1%) became infected with severe acute respiratory syndrome coronavirus 2. The mean duration of time between hospital discharge and the follow-up positive COVID-19 test was 22.1 ± 12.3 days (range, 4–50 days). Eleven (31.4% of postoperative COVID-19 infections, 0.3% of total cases) of the newly diagnosed COVID-19 infections occurred within 14 days of hospital discharge. On multivariable logistic regression, living in the Southwest (adjusted odds ratio, 6.8) and single-unit increase in age-adjusted Charlson comorbidity index (adjusted odds ratio, 1.2) increased the odds of postoperative COVID-19 infection. Perioperative complications were not significantly higher in patients with a history of positive COVID-19 than those without a history of COVID-19, although the mean duration of time between previous COVID-19 diagnosis and surgery was 97 days (14 weeks). Conclusion In this large multicenter prospective cohort study of benign gynecologic surgeries, only 1.1% of patients developed a postoperative COVID-19 infection, with 0.3% of infection in the immediate 14 days after surgery. The incidence of postoperative complications was not different in those with and without previous COVID-19 infections.Item Urinary Biomarkers Under Investigation for Overactive Bladder Syndrome(Springer, 2015-12) Guirguis, Nayera; Heit, Michael; Department of Obstetrics and Gynecology, IU School of MedicineOveractive bladder (OAB) is a symptom syndrome of urinary urgency, frequency, nocturia, and urge incontinence suggestive of lower urinary tract dysfunction. Detrusor overactivity (DO) during urodynamic testing may be the cause of symptoms in 54–70 % of OAB study participants. The identification of urinary biomarkers is warranted due to the high false negative rate of urodynamic testing results for the diagnosis of DO and for the evaluation of treatment response in study participants with OAB symptoms. We reviewed the published literature on urinary biomarkers under investigation for OAB with Pub Med up to June 2015 using search keywords that included “overactive bladder,” “nerve growth factor (NGF),” “brain-derived nerve growth factor (BDNF),” “prostaglandins,” “cytokines,” and “CRP.” Current evidence suggests that NGF and BDNF appear to be most promising candidates for urinary biomarkers for the diagnosis and the evaluation treatment response.Item Validating the Postdischarge Surgical Recovery Scale 13 as a Measure of Perceived Postoperative Recovery After Laparoscopic Sacrocolpopexy(Wolters Kluwer, 2017-03) Carpenter, Janet S.; Heit, Michael; Chen, Chen X.; Stewart, Ryan; Hamner, Jennifer; Rand, Kevin L.; School of NursingObjectives No postoperative recovery measurement tools have been validated among women undergoing laparoscopic sacrocolpopexy for pelvic organ prolapse, which impedes development and testing of strategies to improve recovery. The purpose of this study was to evaluate the performance of the Postdischarge Surgical Recovery Scale (PSR) as a measure of perceived recovery in laparoscopic sacrocolpopexy patients. Methods Women (N = 120) with stage 2 or higher pelvic organ prolapse undergoing laparoscopic sacrocolpopexy completed a 15-minute postoperative survey (days 7, 14, 42, and 90 [each ± 3 days]) which included the 15-item PSR. A confirmatory factor analysis was conducted using data from 14 days postsurgery, when patients would have begun to recover, but there was likely to be substantial variability in recovery across patients. We also assessed validity and explored sensitivity to change over time and minimally important difference values. Results Confirmatory factor analysis indicated a good fitting model for a reduced version of the PSR (ie, PSR13). Regressions showed that the PSR13 prospectively predicted single-item recovery scores. The PSR13 recovery significantly improved from days 7 to 42, suggesting the PSR13 is sensitive to change. Descriptive statistics including minimally important differences are reported. The minimally important difference was estimated to be around 5 points. Conclusions The PSR13 is a psychometrically sound tool for measuring recovery over time in this population. Its short length makes it an ideal postoperative recovery measure in clinical practice or research.